Radiological Diagnosis for Posttraumatic Olfactory Dysfunction

Objective : To evaluate objectively the sites of injury in patients with posttraumatic olfactory deficits and to suggest the diagnostic procedure for evaluation of posttraumatic anosmia. Methods : Ten patients with posttraumatic olfactory dysfunction were examined by means of olfactory testing, sinoscopy, contrast filled paranasal sinus computed tomography(contrast filled PNS CT) and magnetic resonance imaging(MRI). Five normal persons without olfactory dysfunction were also evauluated. The aerodynamic patency of olfactory cleft was examined by contrast filled PNS CT. The olfactory system(oflactory bulbs, olfactory tracts, inferior frontal region, hippocampi, or temporal lobes) was investigated in detail with MRI. The difference in the size of the olfactory bulb between normal volunteers and anosmic patients was evaluated by Student's t test. Results : Contrast filled dynamic CT scan was useful method for the evaluation of dynamic patency of the olfactory cleft. Paranasal CT scan of the all anosmic patients showed dynamic reflux of contrast media in olfactory cleft on valsalva maneuver. For the largest cross-sectional area and great height, the difference in olfactory bulb size between normal volunteers and patients was statistically significant(p<0.001) in MRI study. Conclusion : Posttraumatic anosmia was completely evaluated by olfactory testing, sinoscopy, and contrast filled CT scan for differentiation between conductive type and neurogenic type. Neurogenic anosmia was confirmed by perfect localization with MRI study.ope

Dural Arteriovenous Malformation Associated with Meningioma: Spontaneous Disappearance after Tumor Removal

Dural arteriovenous malformations may be congenital, but most dural arteriovenous malformations are acquired lesions. The acquired dural arteriovenous malformations are rarely associated with brain tumors. We describe a case of dural arteriovenous malformation at the non-dominant transverse-sigmoid sinus associated with a convexity meningioma on the same side. The lesion was spontaneously disappeared after removal of the meningioma, even though the dural arteriovenous malformation was not manipulated. The authors describe a possible pathophysiology of dural arteriovenous malformations associated with tumors at the remote area and spontaneous closure after tumor resection.ope

Isolated Distal Leg Weakness due to a Small Cerebral Infarction Masquerading as a Spinal Lesion

Acute stroke with isolated monoparesis manifesting as distal weakness of a single lower extremity has rarely been described. We report two patients with small cortical infarction who had distal weakness of a single lower extremity. In both cases, diffusion-weighted image (DWI) was used to detect small lesions in the contralateral cortex. These cases illustrate that small cortical infarction can cause isolated monoparesis limited to distal part of the leg and it may be misdiagnosed as spinal lesions, especially when lower back pain and transient sensory symptoms are accompanied. In case of the abrupt onset of weakness limited to one lower limb, the possibility of stroke should be considered and careful attention to identify cortical lesions using magnetic resonance imaging, especially DWI is required.ope

Dissecting Aneurysm of the Posterior Cerebral Artery Masquerading as Saccular Giant Aneurysm

The aneurysm nature and configuration in a giant aneurysm of the PCA is important and careful angiographic examination is needed. We present a case of dissecting aneurysm of the posterior cerebral artery masquerading as saccular giant aneurysm. A 17-year-old man presented with subarachnoid haemorrhage. Cerebral angiograms on admission showed a giant saccular aneurysm with wide neck at P1-P2 junction. The patient underwent endovascular coils embolization and extraventricular drainage of cerebrospinal fluid successfully. However, the patient was aggravated neurologically and got the rebleeding on postembolization 8 days. Repeat cerebral angiograms revealed dilated P1 segment with aneurysmal change of P2 segment. We report the angiographic feature and unusual clinical course and discuss the endovascular treatment of dissecting aneurysms.ope

A Case of Pure Trigeminal Motor Neuropathy

Pure trigeminal motor neuropathy is a trigeminal motor dysfunction, unaccompanied by trigeminal sensory signs and without affecting other cranial nerves. A 61-year-old woman was found to have left hemifacial swelling and trigeminal motor paralysis without sensory symptoms. Blink reflex and trigeminal nerve somatosensory evoked potentials were normal. Needle electromyographic examination showed neurogenic changes in the left temporalis and masseter muscles. Brain MRI revealed wasting and fatty degeneration of muscles innervated by trigeminal nerve. We report here on a case of pure trigeminal motor neuropathy with a review of the literature.ope

Penetrating Injury of Face and Neck with the Vertebral Artery Injury - A Case Report

With the exception of gun shot wound, the incidence of penetrating injury of face and neck areas nonorganic foreign bodies is relative low. But the diagnostic evaluation and therapeutic management of penetrating facial wounds need careful decision, when the anatomic proximity of the major vessels and nerve is considered. Penetrating facial trauma with concomitant vascular injury present challenging problems, the immediate complication of this vascular injury are severe bleeding, hematoma formation, shock, obstruction of airway. The vascular injury is conformed by angiography. In this report, a industrial tool(long tack) fired by explosive air is penetrated into face and to neck. In angiograms penetrating injury of the vertebral artery is detected. We performed the embolization of the vertebral artery with coils and manual removal of the foreign body without any complication was followed.ope

Endovascular Treatment of a Traumatic Carotid-Jugular Fistula by Using Stent-Graft

Traumatic arteriovenous fistulas following carotid artery injuries are rare. Treatment of carotid artery-to-jugular vein fistula requires direct closure of the fistula or occlusion of the carotid artery above and below the level of the fistula, by a surgical or endovascular approach. A 32-year-old man presented with right-sided pulsatile neck swelling and left-sided limb weakness 2 days following a stab wound. Neck computed tomography demonstrated a vascular mass protruding the anterior neck. Digital subtraction arteriography demonstrated a bilobular large internal carotid artery pseudoaneurysm just distal to its bifurcation. There was simultaneous opacification of a dilated left internal jugular vein indicating a high-flow internal carotid-internal jugular fistula. A balloon-expandable stent-graft was delivered and successfully positioned across the fistula. The arteriovenous fistula and pseudoaneurysm were completely disappeared and the right internal carotid artery was preserved well. The stent-graft is a promising technology to obliterate the fistula and preserve the parent artery with relative safety.ope

Pain Control with Continuous Infusion of Epidural Morphine and Bupivacaine after Lumbar Spinal Surgery: A Prospective Study

Objective : The purpose of this non randomized prospective study was to verify the effect of pain control in small doses of epidural morphine and bupivacaine through continuous infusion for 48 hours. Patients and Methods : Thirty-five patients who underwent spine surgery including laminectomy, fusion with fixation were assigned into two groups ; pain control group(n＝20) and control group(n＝15). Pain score was measured on a visual analogue scale(VAS). A continuous infusor was used to give morphine and bupivacaine continuously via indwelling epidural catheter which was placed before closure of muscles in pain control group. Results : Mean scores(VAS) of pain control group were between 1.3 and 2.1 from the 30 min to the 72 hour, but the lowest mean score in the control group was about 2.6 at the 72 hour. Although a number of extra-analgesics were used in control group, differences of mean scores were statistically significant till 24 hour in pain control group. The patients in pain control group was less painful than the patients in control group from 24 hour till 72 hour, but it was statistically insignificant. There were some side effects such as nausea/vomiting, pruritus, urinary retention which existed transiently, but there was no respiratory depression. Conclusion : It was concluded that the early postoperative pain can be easily and safely controlled with continuous infusion of epidural morphine and bupivacaine in small doses.ope

Role of Homocysteine in the Post-stroke Depression

Background : The risk of depression after stroke is influenced by various factors such as age, severity of disability, the location of the brain lesion, etc. We examined whether plasma homocysteine and MTHFR genotypes are associated with depression after stroke. Methods : 173 patients with cerebral infarction whose Barthel’s index improved over 90 points were included. Beck Depression Inventory (BDI) was used to evaluate depression, and the patients were divided into two: depression (DG) and non-depression (NDG) groups according to their BDI score (cut off=21). We then analyzed factors, including plasma homocysteine and MTHFR genotype. Results : The DG was 49 patients (28.3%) and the NDG were 124 patients (71.7%). The genotype distribution consisted of 22.4%(CC), 57.2%(CT), 20.4%(TT) in DG and 27.4%(CC), 55.5%(CT), 16.1%(TT) in NDG, the frequency of which was not different from that in DG. Age, sex, lesion location (left/right/bilateral, anterior/posterior/lenticulostriatal/ multiple), an interval from the stroke onset to the evaluation, the presence of diabetes mellitus, hypertension, hyperlipidemia, cardiac disease, and family history were not different between the two groups. The plasma homocysteine level was significantly higher in DG (14.70 μmol/L) than NDG (11.51 μmol/L) (OR 1.094;95% CI 1.013-1.180) after controlling of the factors described above. Conclusions : Our results suggest that homocysteine may play a role in the pathogenesis of post-stroke depression and support a vascular depression theory. Early identification of this risk factor may lead to effective therapeutic intervention.ope

Arachnoid Cyst of the Velum Interpositum: Coincidence with Multiple Cranial Neuropathies

Arachnoid cyst of the velum interpositum is unusual and causes symptoms similar to those seen with a third ventricular mass. This report describes a case in which the arachnoid cyst occupied the cistern of the velum interpositum and was coincident with multiple cranial neuropathies. The patient was treated by endoscopic fenestration of the cyst. The surgery resulted in decreased in the size of the cyst but aggravation of cranial neuropathies. The patient underwent methylprednisolone pulse therapy and intravenous immunoglobulin administration under the impression of the multiple cranial neuropathies and recovered completely 3 months later. The authors conclude that combined neurological disease that needs medical treatment should be differentiated and priority of the treatment should be determined carefully if arachnoid cyst is associated with unrelated or ambiguous neurological symptoms and signs. Careful considerations of cause and effect may avoid an unnecessary surgical manipulation.ope